Evolution of Magnetic Resonance Imaging Lesions at the Sacroiliac Joints During and After Pregnancy by Serial Magnetic Resonance Imaging From Gestational Week Twenty to Twelve Months Postpartum

Abstract

Objective. Sacroiliac (SI) joint magnetic resonance imaging (MRI) findings simulating sacroiliitis related to axial spondyloarthritis (SpA) may occur in women before and after birth. This study was undertaken to explore the prevalence, evolution, and topography of SI joint MRI lesions in pregnant and postpartum women.Methods. A prospective cohort study included 103 first-time mothers who underwent up to 5 serial SI joint MRI between gestational week 20 and 12 months postpartum. After calibration, 3 assessors independently evaluated bone marrow edema (BME), including sacroiliitis according to the Assessment of SpondyloArthritis international Society (ASAS), as well as structural lesions, using the Spondyloarthritis Research Consortium of Canada (SPARCC) and a novel 2-plane assessment method.Results. BME was frequent both during pregnancy and the postpartum period, peaking at 3 months postpartum with a prevalence of 69% (SPARCC) and 80% (2-plane method), but still present in 54% (SPARCC) and 58% (2-plane method) of subjects at 12 months postpartum. At 12 months postpartum, sacroiliitis according to the current ASAS definition was met in 41%, while 21% and 14% of women fulfilled the newly proposed ASAS MRI thresholds for active and structural SI joint lesions, respectively. BME clustered in the anterior middle joint portions at all time points, and ligamentous BME was rare. At 12 months postpartum, SPARCC erosion scores ≥3 (ASAS threshold) were observed in only 2.8% of women.Conclusion. At 12 months postpartum, 41% of women met the current ASAS sacroiliitis definition, which may result in false-positive assignments of axial SpA diagnosis in postpartum women with back pain. The topographical BME distribution and virtually absent erosions (ASAS threshold) at 12 months postpartum may help discriminate postpartum strain-related conditions from axial SpA-related sacroiliitis.

Biomechanics in the onset and severity of spondyloarthritis: a force to be reckoned with

“…65 In a study of 103 primigravida mothers evaluated using serial MRI scans during and after pregnancy, BME was noted as long as 12 months post partum. 66 BME peaked at 3 months postpartum, and 41% of the women met the current ASAS sacroiliitis definition at 12 months. The virtual absence of erosions and topographical BME distribution (involvement of anterior middle portions of the cartilaginous SIJ without a widespread lesion distribution) can help distinguish between the two entities.…”

Reactive Oxygen Species-Responsive Sequentially Targeted AIE Fluorescent Probe for Precisely Identifying the Atherosclerotic Plaques

“…Clustering of lipid-loaded macrophages at the artery vessel wall usually led to early lesions of atherosclerotic plaques and gradually developed into a lipid core into the vascular lumen. 13 Atherosclerosis was the major cause of myocardial infarction and stroke, which usually resulted from occlusion of arteries following atherosclerotic plaque rupture. 34 Therefore, lipid accumulation was a key feature of the resulted in a weak red fluorescence signal around the aortic wall (Figure 4B).…”

“…8,9 Thence, it is highly important to efficiently recognize the foam cells and then precisely identify the morphology and disperse distribution of the plaques for physicians to make timely clinical decisions and perform proactive interventions as early as possible. 10 Currently, computed tomography (CT), 11 optical coherence tomography (OCT), 12 magnetic resonance imaging (MRI), 13 and ultrasonography (US) 14 are utilized to detect the structural and anatomic features of atherosclerotic plaques. 6 However, these conventional methods always have difficulty in providing the detailed information for atherosclerotic lesions owing to their intrinsically low spatial resolution.…”

“…Currently, computed tomography (CT), optical coherence tomography (OCT), magnetic resonance imaging (MRI), and ultrasonography (US) are utilized to detect the structural and anatomic features of atherosclerotic plaques . However, these conventional methods always have difficulty in providing the detailed information for atherosclerotic lesions owing to their intrinsically low spatial resolution .…”

Novel insights into the anatomy and histopathology of the sacroiliac joint and correlations with imaging signs of sacroiliitis in case of axial spondyloarthritis

“…Increased pelvic tilt in females when compared to males, variations in the shape and contours of articular cartilaginous surfaces, and frequent anatomical variations in females may therefore lead to non-inflammatory changes on MRI (Jurik, 2023;Ulas et al, 2023). Moreover, bone marrow edema is frequent during pregnancy and also during postpartum, which is still present in more than half of patients at 12 months postpartum (Kiil et al, 2023).…”